infectious diseases

First day on the ID team. As I had expected the clueless-sounding secretary had indeed misinformed about how and to whom to report. I found one of the ID attendings, looking hassled, trying to run out to a meeting. Discovering that none of his colleagues had any plans to pick me up, he stopped for five minutes to give a schedule sheet, and tell me to go get a computer password, and then latch on to the fellow.

Computer password. Yes. The big hospital, the hospital I love, the hospital I knew everything about, switched over the weekend to an Electronic Medical Record. <cue Darth Vader music, and breathing too> The hospital has been in chaos ever since, and I’m sure the horror stories are only starting to surface: a patient bleeding horrendously, and hemoglobin/hematocrit and coag values unavailable because the lab stuff was not uploading to the computers properly; patients all over the ICU, and the pharmacy nonfunctional all weekend; those are only the ones I’ve heard so far. I would be surprised to learn that at least a few deaths over the weekend were not at least partially attributable to the changeover.

The only thing restraining the hospital from a total riot today, as most of the staff came back and encountered the monster for the first time, was the swarm of tech support people, imported for the purpose, dressed in brilliant and eye-catching T-shirts. They were present in a ratio of at least 1:3, and were actually instantly available, walking around and saying to everyone in front of a computer, “Do you need any help?” To which the answer was usually yes.

The punchline? At this teaching hospital, the people who spent 9+ months developing this EMR apparently decided that medical students did not need to have any access to the system. You understand that not only labs and nurses’ notes, but vital signs – vital signs – vital signs, those little numbers that let you know whether your patient is crashing down the tubes at this very moment – vital signs are locked into the computers. And access is via fingerprint – so you can’t even scrounge a password from a friendly resident, like we used to do for the imaging program. There is absolutely no provision for medical students. Not, they were busy and didn’t have time to orient us or get us fingerprinted; but, they completely left us out of the calculations. One friendly IT guy who was helping the fellow get her passwords straightened out offered to set me up. But my name wasn’t even in the universe of potentially-allowable-participants.

One of the chief functions of medical students on the wards is to look up lab values and vital signs while the residents and attending are discussing a patient.

The lady in charge of helping medical students took one look at me in her office and exclaimed, “It’s not my fault, I didn’t do it, I can’t help it, there’s nothing I can do about it right now – I’ve talked to X and Z, they’re aware of the problem, I promise I’ll let you know if they figure anything out.” So I just grinned and took my meal card. It wasn’t her fault. But boy, if the responsible characters decide that they don’t need to do anything about it, I will not only write letters to everyone in the hospital administration and IT, I will camp out in their offices. Try to run a teaching hospital without letting the medical students see the vital signs, indeed! (I’ve heard rumors that the people behind the switchover would be just as pleased not to have dumb, redundant medical students writing things in the legal record, which is why I’m not discounting the idea that this was done on purpose. But you can’t learn anything if you’re not writing notes.)

So my day consisted of looking over the fellow’s shoulder while she rounded, smiling mildly at her curses at the computer, and generally pestering the poor harried nurses to let me borrow the computers before the attendings exploded in frustration at the lack of a certain piece of information. In clinic I was sent to see two people, and write the assessment and plan by myself, and I enjoyed it more than any medicine clinic I remember so far. We’ll hope that continues for the next two weeks.

(If you’ve concluded that I’m not a fan of computers in medicine, you would be correct.)